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Cavalcante JGT, Ribeiro VHDS, Marqueti RDC, Paz IDA, Bastos JAI, Vaz MA, Babault N, Durigan JLQ. Effect of muscle length on maximum evoked torque, discomfort, contraction fatigue, and strength adaptations during electrical stimulation in adult populations: A systematic review. PLoS One 2024; 19:e0304205. [PMID: 38857245 PMCID: PMC11164398 DOI: 10.1371/journal.pone.0304205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/08/2024] [Indexed: 06/12/2024] Open
Abstract
Neuromuscular electrical stimulation (NMES) can improve physical function in different populations. NMES-related outcomes may be influenced by muscle length (i.e., joint angle), a modulator of the force generation capacity of muscle fibers. Nevertheless, to date, there is no comprehensive synthesis of the available scientific evidence regarding the optimal joint angle for maximizing the effectiveness of NMES. We performed a systematic review to investigate the effect of muscle length on NMES-induced torque, discomfort, contraction fatigue, and strength training adaptations in healthy and clinical adult populations (PROSPERO: CRD42022332965). We conducted searches across seven electronic databases: PUBMED, Web of Science, EMBASE, PEDro, BIREME, SCIELO, and Cochrane, over the period from June 2022 to October 2023, without restricting the publication year. We included cross-sectional and longitudinal studies that used NMES as an intervention or assessment tool for comparing muscle lengths in adult populations. We excluded studies on vocalization, respiratory, or pelvic floor muscles. Data extraction was performed via a standardized form to gather information on participants, interventions, and outcomes. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for cross-over trials and the Physiotherapy Evidence Database scale. Out of the 1185 articles retrieved through our search strategy, we included 36 studies in our analysis, that included 448 healthy young participants (age: 19-40 years) in order to investigate maximum evoked torque (n = 268), contraction fatigability (n = 87), discomfort (n = 82), and muscle strengthening (n = 22), as well as six participants with spinal cord injuries, and 15 healthy older participants. Meta-analyses were possible for comparing maximal evoked torque according to quadriceps muscle length through knee joint angle. At optimal muscle length 50° - 70° of knee flexion, where 0° is full extension), there was greater evoked torque during nerve stimulation compared to very short (0 - 30°) (p<0.001, CI 95%: -2.03, -1.15 for muscle belly stimulation, and -3.54, -1.16 for femoral nerve stimulation), short (31° - 49°) (p = 0.007, CI 95%: -1.58, -0.25), and long (71° - 90°) (p<0.001, CI 95%: 0.29, 1.02) muscle lengths. At long muscle lengths, NMES evoked greater torque than very short (p<0.001, CI 95%: -2.50, -0.67) and short (p = 0.04, CI 95%: -2.22, -0.06) lengths. The shortest quadriceps length generated the highest perceived discomfort for a given current amplitude. The amount of contraction fatigability was greater when muscle length allowed greater torque generation in the pre-fatigue condition. Strength gains were greater for a protocol at the optimal muscle length than for short muscle length. The quality of evidence was very high for most comparisons for evoked torque. However, further studies are necessary to achieve certainty for the other outcomes. Optimal muscle length should be considered the primary choice during NMES interventions, as it promotes higher levels of force production and may facilitate the preservation/gain in muscle force and mass, with reduced discomfort. However, a longer than optimal muscle length may also be used, due to possible muscle lengthening at high evoked tension. Thorough understanding of these physiological principles is imperative for the appropriate prescription of NMES for healthy and clinical populations.
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Affiliation(s)
- Jonathan Galvão Tenório Cavalcante
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Victor Hugo de Souza Ribeiro
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Rita de Cássia Marqueti
- Molecular Analysis Laboratory, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Isabel de Almeida Paz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Júlia Aguillar Ivo Bastos
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
| | - Marco Aurélio Vaz
- Exercise Research Laboratory, School of Physical Education, Physical Therapy and Dance, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Nicolas Babault
- Centre d’Expertise de la Performance, INSERM UMR1093-CAPS, UFR des Sciences du Sport, University of Burgundy Franche-Comté, Besançon, Dijon, France
| | - João Luiz Quagliotti Durigan
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Physical Education, University of Brasília, Brasília, Distrito Federal, Brazil
- Laboratory of Muscle and Tendon Plasticity, Graduate Program of Rehabilitation Sciences, University of Brasília, Brasília, Distrito Federal, Brazil
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Gottlieb U, Hayek R, Hoffman JR, Springer S. Exercise combined with electrical stimulation for the treatment of chronic ankle instability - A randomized controlled trial. J Electromyogr Kinesiol 2024; 74:102856. [PMID: 38198892 DOI: 10.1016/j.jelekin.2023.102856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 12/03/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To compare the short, medium, and long-term effects of balance exercises combined with either peroneal neuromuscular electrical stimulation (NMES) or peroneal transcutaneous electrical nerve stimulation (TENS) on dynamic postural control and patient reported outcome measures (PROMs) in patients with chronic ankle instability (CAI). METHODS Thirty-four participants with CAI were randomly assigned to a 12-session home based exercise program combined with NMES (Ex-NMES) or TENS (Ex- TENS). Baseline postural control was tested with the modified Star Excursion Balance Test (mSEBT) and time to stabilization (TTS) after a single-leg drop-jump. The self-reported function was measured using the Cumberland Ankle Instability Tool (CAIT), the Identification of Functional Ankle Instability (IdFAI), and the Sports subscale of the Foot and Ankle Ability Measure (FAAMSport). RESULTS Both groups showed significant improvements in all self-reported outcome measures at the 12-month follow-up. Subjects in the Ex-NMES group had significantly better IdFAI (-4.2 [95% CI -8.1, -0.2]) and FAAMSport (13.7 [95% CI 2.2, 25.2]) scores at 6- and 12-month follow-up, respectively, compared to the Ex-TENS group. Medium to large between-group effect sizes were observed in self-reported functional outcomes and the mSEBT. CONCLUSION The consistent trend of improvement in self-reported functional outcomes when training is combined with NMES compared with training with TENS may indicate a potential benefit that should be further investigated as a treatment for patients with CAI.
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Affiliation(s)
- Uri Gottlieb
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
| | - Roee Hayek
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Jay R Hoffman
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel
| | - Shmuel Springer
- Neuromuscular and Human Performance Laboratory, Department of Physiotherapy, Ariel University, Israel.
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Carvalho MTX, Guesser Pinheiro VH, Alberton CL. Effectiveness of neuromuscular electrical stimulation training combined with exercise on patient-reported outcomes measures in people with knee osteoarthritis: A systematic review and meta-analysis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2062. [PMID: 37926438 DOI: 10.1002/pri.2062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/03/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study examined the effectiveness of neuromuscular electrical stimulation (NMES) added to the exercise or superimposed on voluntary contractions on patient-reported outcomes measures (PROMs) in people with knee osteoarthritis (OA). METHODS This systematic review was described according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomized controlled trials (RCTs) were obtained from a systematic literature search in five electronic databases (PubMed, PEDro, LILACS, EMBASE, and SPORTDiscus) in April 2022. We described the effects of intervention according to each PROMs (scores for Pain; Self-reported functional ability; Symptoms (hear clicking, swelling, catching, restricted range of motion, and stiffness); Daily living function; Sports function; and Quality of life) and used a random-effect model to examine the impact of NMES plus exercise on pain compared with exercise in people with knee OA. RESULTS Six RCTs (n = 367) were included. In the qualitative synthesis, the systematic literature analysis showed improvement in pain after NMES plus exercise compared with exercise alone in three studies. The other three studies revealed no difference between groups in pain, although similar improvement after treatments. In the meta-analysis, NMES at a specific joint angle combined with exercise was not superior to exercise alone in pain management (standardized mean difference = -0.33, 95% CI = -1.05 to 0.39, p = 0.37). There was no additional effect of NMES on exercise on self-reported functional ability, stiffness, and physical function compared with exercise alone. In only one study, symptoms, activities of daily living, sports function, and quality of life improved after whole-body electrostimulation combined with exercise. CONCLUSION This review found insufficient evidence for the effectiveness of NMES combined with exercise in treating knee OA considering PROMs. While pain relief was observed in some studies, more high-quality clinical trials are needed to support the use of NMES added to the exercise in clinical practice. Electrical stimulation in a whole-body configuration combined with exercise shows promise as an alternative treatment option.
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Needle AR, Tinsley JE, Cash JJ, Koeval BK, Barton JA, Howard JS. The effects of neuromuscular electrical stimulation to the ankle pronators on neural excitability & functional status in patients with chronic ankle instability. Phys Ther Sport 2023; 60:1-8. [PMID: 36634453 DOI: 10.1016/j.ptsp.2022.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Chronic ankle instability (CAI) is associated with decreased neural excitability that negatively impacts function. This study assessed a 2-week neuromuscular electrical stimulation (NMES) or transcutaneous electrical nerve stimulation (TENS) intervention over the ankle pronators on neural excitability, performance, and patient-reported function in patients with CAI. STUDY DESIGN Randomized controlled trial. PARTICIPANTS Twenty participants with CAI completed the study. MAIN OUTCOME MEASURES Participants were assessed for reflexive and corticospinal excitability to the ankle muscles, dynamic balance, side-hop test performance and patient-reported outcomes at baseline, post-intervention (2-weeks), and retention (4-weeks). Between baseline and post-intervention, participants reported for 5 sessions where they received either sub-noxious NMES (n = 11) or sensory-level TENS (n = 9) over the ankle pronators. RESULTS Improved reflexive excitability to the ankle pronators was observed in TENS at post-intervention (p = 0.030) and retention (p = 0.029). Cortical excitability to the dorsiflexors increased in TENS at post-intervention (p = 0.017), but not at retention (p = 0.511). No significant changes were found for other neural measures, balance ability, hopping, or patient-reported function (p > 0.050). CONCLUSIONS Our results suggest TENS modified neural excitability; however, these changes were not enough to impact clinical function. While TENS may be capable of neuromodulation, it may require rehabilitative exercise to generate lasting changes. NCT04322409. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- Alan R Needle
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA; Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA.
| | - Jennifer E Tinsley
- Department of Athletic Training and Clinical Nutrition, University of Kentucky, Lexington, KY, USA
| | - Jasmine J Cash
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, SC, USA
| | - Blake K Koeval
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jacob A Barton
- Department of Public Health & Exercise Science, Appalachian State University, Boone, NC, USA
| | - Jennifer S Howard
- Department of Rehabilitation Sciences, Appalachian State University, Boone, NC, USA
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Hardy EJ, Hatt J, Doleman B, Smart TF, Piasecki M, Lund JN, Phillips BE. Post-operative electrical muscle stimulation attenuates loss of muscle mass and function following major abdominal surgery in older adults: a split body randomised control trial. Age Ageing 2022; 51:afac234. [PMID: 36315433 PMCID: PMC9621149 DOI: 10.1093/ageing/afac234] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Significant losses of muscle mass and function occur after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in post-operative patients is limited. This study assesses the efficacy of NMES for attenuating muscle atrophy and functional declines following major abdominal surgery in older adults. METHODS Fifteen patients undergoing open colorectal resection completed a split body randomised control trial. Patients' lower limbs were randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on post-operative days (PODs) 1-4. Ultrasound measurements of Vastus Lateralis cross-sectional area (CSA) and muscle thickness (MT) were made preoperatively and on POD 5, as was dynamometry to determine knee extensor strength (KES). Change in CSA was the primary outcome. All outcomes were statistically analysed using linear mixed models. RESULTS NMES significantly reduced the loss of CSA (-2.52 versus -9.16%, P < 0.001), MT (-2.76 versus -8.145, P = 0.001) and KES (-10.35 versus -19.69%, P = 0.03) compared to CON. No adverse events occurred, and patients reported that NMES caused minimal or no discomfort and felt that ~90-minutes of NMES daily would be tolerable. DISCUSSION NMES reduces losses of muscle mass and function following major abdominal surgery, and as such, may be the promising tool for post-operative recovery. This is important in preventing long-term post-operative dependency, especially in the increasingly frail older patients undergoing major abdominal surgery. Further studies should establish the efficacy of bilateral NMES for improving patient-centred outcomes.
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Affiliation(s)
- Edward J Hardy
- Department of General Surgery, Royal Derby Hospital, Derby DE22 3NE, UK
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, NG7 2RD, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
| | - Jacob Hatt
- Department of General Surgery, Royal Derby Hospital, Derby DE22 3NE, UK
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, NG7 2RD, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
| | - Brett Doleman
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
- Department of Anaesthetics, Royal Derby Hospital, Derby DE22 3NE, UK
| | - Thomas F Smart
- Department of General Surgery, Royal Derby Hospital, Derby DE22 3NE, UK
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, NG7 2RD, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
| | - Matthew Piasecki
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, NG7 2RD, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
| | - Jonathan N Lund
- Department of General Surgery, Royal Derby Hospital, Derby DE22 3NE, UK
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
| | - Bethan E Phillips
- Centre of Metabolism, Ageing & Physiology, School of Medicine, University of Nottingham, Royal Derby Hospital Centre, Derby, DE22 3DT, UK
- Nottingham NIHR Biomedical Research Centre, Nottingham, NG7 2RD, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Universities of Nottingham and Birmingham, UK
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Lim MA, Kurniawan AA, Budisusilo W, Siregar YP. Rehabilitation Approach Postarthroscopic Partial Meniscectomy of Medial Meniscus in an Elite Track and Field Sprinter: A Case Report. Curr Sports Med Rep 2022; 21:174-185. [PMID: 35703743 DOI: 10.1249/jsr.0000000000000963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | - Wawan Budisusilo
- Eminence Sports Medicine and Human Performance Center, Jakarta, INDONESIA
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Badawy CR, Jan K, Beck EC, Fleet N, Taylor J, Ford K, Waterman BR. Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction. Arthrosc Sports Med Rehabil 2022; 4:e103-e113. [PMID: 35141542 PMCID: PMC8811493 DOI: 10.1016/j.asmr.2021.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Despite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteria-based milestones may maximize the ability of return to preinjury levels of athletic function.
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Affiliation(s)
- Charles R Badawy
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Kyleen Jan
- University of Illinois College of Medicine, Chicago, Illinois, U.S.A
| | - Edward C Beck
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - Niles Fleet
- Department of Athletics, Wake Forest University, Winston-Salem, North Carolina, U.S.A
| | - Jeffrey Taylor
- Department of Physical Therapy, High Point University, High Point, North Carolina, U.S.A
| | - Kevin Ford
- Department of Physical Therapy, High Point University, High Point, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
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Peng L, Wang K, Zeng Y, Wu Y, Si H, Shen B. Effect of Neuromuscular Electrical Stimulation After Total Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Med (Lausanne) 2021; 8:779019. [PMID: 34926522 PMCID: PMC8677678 DOI: 10.3389/fmed.2021.779019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023] Open
Abstract
Background: This systematic review and meta-analysis aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on quadriceps muscle strength, pain, and function outcomes following total knee arthroplasty (TKA). Methods: PubMed/Medline, Embase, Web of Science, CENTRAL, Scopus, PsycINFO, PEDro, CINAHL, CNKI, and Wanfang were systematically searched for randomized controlled trials (RCTs) from their inception to 18 June 2021. Results: Nine RCTs that involving 691 patients were included in the meta-analysis. Our pooled analysis showed that NMES improved quadriceps muscle strength after TKA within 1 months [standardized mean difference (SMD): 0.81; 95% CI: 0.51–1.11], 1–2 months (SMD: 0.55; 95% CI: 0.13–0.97), 3–4 months (SMD: 0.42; 95% CI: 0.18–0.66), and 12–13 months (SMD: 0.46; 95% CI: 0.18–0.74), pain between 1 and 2 months [mean difference (MD): −0.62; 95% CI: −1.04 to −0.19], pain between 3 and 6 months (MD: −0.44; 95% CI: −0.74 to −0.14) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) between 3 and 4 months (MD: −0.43; 95% CI: −0.82 to −0.05), timed up and go test (TUG) within 1 month (MD: −2.23; 95% CI: −3.40 to −1.07), 3 minutes walk test between 3 and 6 months (MD: 28.35; 95% CI: 14.55–42.15), and SF-36 MCS between 3 and 6 months after TKA (MD: 4.20, 95% CI: 2.41–5.98). Conclusion: As a supplementary treatment after TKA, postoperative NMES could improve the short-term to long-term quadriceps muscle strength, mid-term pain, and mid-term function following TKA. However, many outcomes failed to achieve statistically meaningful changes and minimal clinically important difference (MCID), thus the clinical benefits remained to be confirmed. Level of Evidence: Therapeutic level I. Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021265609.
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Affiliation(s)
- Linbo Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Kexin Wang
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Zeng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuangang Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Haibo Si
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Arthrogenic Muscle Inhibition: Best Evidence, Mechanisms, and Theory for Treating the Unseen in Clinical Rehabilitation. J Sport Rehabil 2021; 31:717-735. [PMID: 34883466 DOI: 10.1123/jsr.2021-0139] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Arthrogenic muscle inhibition (AMI) impedes the recovery of muscle function following joint injury, and in a broader sense, acts as a limiting factor in rehabilitation if left untreated. Despite a call to treat the underlying pathophysiology of muscle dysfunction more than three decades ago, the continued widespread observations of post-traumatic muscular impairments are concerning, and suggest that interventions for AMI are not being successfully integrated into clinical practice. OBJECTIVES To highlight the clinical relevance of AMI, provide updated evidence for the use of clinically accessible therapeutic adjuncts to treat AMI, and discuss the known or theoretical mechanisms for these interventions. EVIDENCE ACQUISITION PubMed and Web of Science electronic databases were searched for articles that investigated the effectiveness or efficacy of interventions to treat outcomes relevant to AMI. EVIDENCE SYNTHESIS 122 articles that investigated an intervention used to treat AMI among individuals with pathology or simulated pathology were retrieved from 1986 to 2021. Additional articles among uninjured individuals were considered when discussing mechanisms of effect. CONCLUSION AMI contributes to the characteristic muscular impairments observed in patients recovering from joint injuries. If left unresolved, AMI impedes short-term recovery and threatens patients' long-term joint health and well-being. Growing evidence supports the use of neuromodulatory strategies to facilitate muscle recovery over the course of rehabilitation. Interventions should be individualized to meet the needs of the patient through shared clinician-patient decision-making. At a minimum, we propose to keep the treatment approach simple by attempting to resolve inflammation, pain, and effusion early following injury.
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